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Effect of pronase as mucolytic agent on imaging quality of magnifying endoscopy

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World Journal of Gastroenterology 2015年第8期21卷 2483-2489页

作者： Gwang Ha Kim Yu Kyung Cho Jae Myung Cha Sun-Young Lee il-kwun chung Department of Internal Medicine Pusan National University School of Medicine Department of Internal Medicine The Catholic University of Korea Department of Internal Medicine Kyung Hee University Hospital at Gang Dong Department of Internal Medicine Konkuk University Medical Center Department of Internal Medicine Soonchunhyang University

AIM:To investigate the efficacy of premedication with pronase,a proteolytic enzyme,in improving imagequality during magnifying ***:The study was of a blinded,randomized,prospective *** were assigned to groups administered oral premedication of either pronase and simethicone(Group A)or simethicone alone(Group B).First,the gastric mucosal visibility grade(1-4)was determined during conventional endoscopy,and then a magnifying endoscopic examination was *** quality of images obtained by magnifying endoscopy at the stomach and the esophagus was scored from1 to 3,with a lower score indicating better *** endoscopist used water flushes as needed to obtain satisfactory magnifying endoscopic *** main study outcomes were the visibility scores during magnifying endoscopy and the number of water ***:A total of 144 patients were enrolled,and data from 143 patients(M:F=90:53,mean age 57.5 years)were *** visibility score was significantly higher in the stomach following premedication with pronase(73%with a score of 1 in Group A vs 49%in Group B,Pility scores(67%with a score of 1in Group A vs 58%in Group B).Fewer water flushes[mean 0.7±0.9 times(range:0-3 times)in Group A vs 1.9±1.5 times(range:0-6 times)in Group B,Pility score was also lower in Group A(4.9±1.5 vs 8.3±1.8in Group B,P<0.01).CONCLUSION:The addition of pronase to simethicone premedication resulted in clearer images during magnifying endoscopy and reduced the need for water flushes.

关键词： Pronase Narrow-band imaging,EndoscopyImage enhance

Aortoduodenal fistula and aortic aneurysm secondary to biliary stent-induced retroperitoneal perforation

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World Journal of Gastroenterology 2008年第19期14卷 3095-3097页

作者： Tae Hoon Lee Do Hyun Park Ji-Young Park Suck-Ho Lee il-kwun chung Hong Soo Kim Sang-Heum Park Sun-Joo Kim Division of Gastroenterology Department of Internal MedicineSoonchunhyang University College of Medicine Division of Gastroenterology Department of Internal MedicineUniversity of Ulsan College of Medicine

Duodenal perforations caused by biliary prostheses are not uncommon, and they are potentially life threatening and require immediate treatment. We describe an unusual case of aortic aneurysm and rupture which occurred after retroperitoneal aortoduodenal fistula formation as a rare complication caused by biliary metallic stent-related duodenal perforation. To our knowledge, this is the first report describing a lethal complication of a bleeding, aortoduodenal fistula and caused by biliary metallic stent-induced perforation.

关键词： Stents Retroperitoneal perforation Aorticaneurysm Fistula

Modified rendezvous intrahepatic bile duct cannulation technique to pass a PTBD catheter in ERCP

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World Journal of Gastroenterology 2010年第42期16卷 5388-5390页

作者： Tae Hoon Lee Sang-Heum Park Sae Hwan Lee Chang-Kyun Lee Suck-Ho Lee il-kwun chung Hong Soo Kim Sun-Joo Kim Division of Gastroenterology Department of Internal MedicineSoon Chun Hyang University College of MedicineCheonan Hospital23-20 Bongmyung-dongCheonan-siChungcheongnam-do330-721South Korea

The rendezvous procedure combines an endoscopic technique with percutaneous transhepatic biliary drainage(PTBD).When a selective common bile duct cannulation fails,PTBD allows successful drainage and retrograde access for subsequent rendezvous ***,rendezvous procedures such as the PTBDassisted over-the-wire cannulation method,or the parallel cannulation technique,may be available when a bile duct cannot be selectively *** selective intrahepatic bile duct(IHD) cannulation fails,this modified rendezvous technique may be a feasible *** report the case of a modified rendezvous technique,in which the guidewire was retrogradely passed into the IHD through the C2 catheter after end-to-end contact between the tips of the sphincterotome and the C2 catheter at the ampulla's orifice,in a 39-year-old man who had been diagnosed with gallbladder carcinoma with a metastatic right IHD *** this procedure may be a feasible and timesaving technique.

关键词： Endoscopic retrograde cholangiopancreatography Intrahepatic bile duct Rendezvous technique

Endoscopic diverticulotomy with an isolated-tip needle-knife papillotome (Iso-Tome) and a fitted overtube for the treatment of a Killian-Jamieson diverticulum

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World Journal of Gastroenterology 2008年第42期14卷 6589-6592页

作者： Chang Kyun Lee il-kwun chung Ji-Young Park Tae Hoon Lee Suck-Ho Lee Sang-Heum Park Hong-Soo Kim Sun-Joo Kim Division of Gastroenterology Department of Internal Medicine Soonchunhyang University College of Medicine Cheonan Hospital Cheonan Choongnam 330-721 South Korea

A Killian-Jamieson diverticulum （KID） is an unfamiliar and rare cervical esophageal diverticulum. This diverticulum originates on the anterolateral wall of the proximal cervical esophagus through a muscular gap （the Killian-Jamieson space） below the cricopharyngeal muscle and lateral to the longitudinal muscle of the esophagus. To date, only surgical treatment has been recommended for a symptomatic KJD due to its close proximity to the recurrent laryngeal nerve and the concern of possible nerve injury. Recently, traditional open surgery for a symptomatic KJD is being challenged by the development of new endoscopic techniques and devices. We present here a case of a symptomatic KID that was successfully treated with the flexible endoscopic diverticulotomy using two new devices. An isolated-tip needle-knife papillotome （Iso-Tome） was used for the dissection of the tissue bridge of the diverticulum. And a flexible overtube with a modified distal end （a fitted overtube） was used for adequate visualization of the tissue bridge of the diverticulum and protection of the surrounding tissue during dissection of the tissue bridge. Our successful experience suggests that the flexible endoscopic diverticulotomy with the use of appropriate endoscopicdevices can be a safe and effective method for the treatment of a symptomatic KJD.

关键词： Esophagus Diverticulum Killian-Jamieson diverticulum Endoscopy Diverticulotomy

Chemical ablation of the gallbladder using alcohol in cholecystitis after palliative biliary stenting

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World Journal of Gastroenterology 2009年第16期15卷 2041-2043页

作者： Tae Hoon Lee Sang-Heum Park Sang Pil Kim Ji-Young Park Chang Kyun Lee il-kwun chung Hong Soo Kim Sun-Joo Kim Division of Gastroenterology Department of Internal MedicineSoonchunhyang University College of MedicineCheonan Hospital

Chemical ablation of the gallbladder is effective in patients at high risk of complications after surgery. Percutaneous gallbladder drainage is an effective treatment for cholecystitis; however, when the drain tube cannot be removed because of recurrent symptoms, retaining it can cause problems. An 82-year-old woman presented with cholecystitis and cholangitis caused by biliary stent occlusion and suspected tumor invasion of the cystic duct. We present successful chemical ablation of the gallbladder using pure alcohol, through a percutaneous gallbladder drainage tube, in a patient who developed intractable cholecystitis with obstruction of the cystic duct after receiving a biliary stent. Our results suggest that chemical ablation therapy is an effective alternative to surgical therapy for intractable cholecystitis.

关键词： Percutaneous cholecystostomy Cholecystitis Biliary stenting Alcohol Chemical therapy

Usefulness of magnifying endoscopy in post-endoscopic resection scar for early gastric neoplasm:A prospective short-term follow-up endoscopy study

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World Journal of Gastroenterology 2009年第3期15卷 349-355页

作者： Tae Hoon Lee il-kwun chung Ji-Young Park Chang Kyun Lee Suck-Ho Lee Hong Soo Kim Sang-Heum Park Sun-Joo Kim Hyun-Deuk Cho Young Hwangbo Division of Gastroenterology Department of Internal MedicineSoonchunhyang University College of MedicineCheonan Hospital23-20 Bongmyung-dongCheonan330-721South Korea Department of Pathology Soonchunhyang University College of MedicineCheonan Hospital23-20 Bongmyung-dongCheonan330-721South Korea Department of Preventive Medicine Soonchunhyang University College of MedicineCheonan Hospital23-20 Bongmyung-dongCheonan330-721South Korea

AIM： To investigate the relationship between postendoscopic resection （ER） scars on magnifying endoscopy （ME） and the pathological diagnosis in order to validate the clinical significance of ME. METHODS： From January, 2007 to June, 2008, 124 patients with 129 post-ER scar lesions were enrolled. Mucosal pit patterns on ME were compared with conventional endoscopy （CE） findings and histological results obtained from targeted biopsies. RESULTS： CE findings showed nodular scars （53/129）, erythematous scars （85/129）, and ulcerative scars （4/129）. The post-ER scars were classified into four pit patterns of sulci and ridges on ME：（ Ⅰ ） 47 round; （Ⅱ） 54 short rod or tubular; （Ⅲ） 19 branched or gyrus-like;and （Ⅳ） 9 destroyed pits. Sensitivity and specificity were 88.9% and 62.5%, respectively, by the presence of nodularity on CE. Erythematous lesions were high sensitivity （100%）, but specificity was as low as 36.7%. The range of the positive predictive va ue （PPV） on CE was as low as 10.6%-25%. Nine type N pit patterns were diagnosed as tumor lesions, and 120 cases of type Ⅰ-Ⅲ pit patterns revealed non-neoplastic lesions. Thus, the sensitivity, specificity, and the PPV of ME were 100%. CONCLUSION： ME findings can detect the presence of tumor in post-ER scar lesions, and make evident the biopsy target site in short-term follow-up. Further large-scale and long-term studies are needed to determine whether ME can replace endoscopic biopsy.

关键词： Endoscopic mucosal resection Endoscopic submucosal dissection Magnifying endoscopy Pitpattern Scar

Long-term follow up of endoscopic resection for type 3 gastric NET

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World Journal of Gastroenterology 2013年第46期19卷 8703-8708页

作者： Yong Hwan Kwon Seong Woo Jeon Gwang Ha Kim Jin il Kim il-kwun chung Sam Ryong Jee Heung Up Kim Geom Seog Seo Gwang Ho Baik Kee Don Choi Jeong Seop Moon Department of Internal Medicine Kyungpook National University Hospital Department of Internal Medicine Busan National University School of Medicine Department of Internal Medicine Catholic University of Korea College of Medicine Department of Internal Medicine Soonchunhyang University Department of Internal Medicine Inje University Pusan Paik Hospital Department of Internal Medicine Jeju National University School of Medicine Department of Internal Medicine Digestive Disease Research InstituteWonkwang University College of Medicine Department of Internal Medicine Hallym University College of Medicine Department of Internal Medicine University of Ulsan College of MedicineAsan Medical Center Department of Internal Medicine Inje University Seoul Paik Hospital

AIM:To clarify the short and long-term results and to prove the usefulness of endoscopic resection in type 3gastric neuroendocrine tumors(NETs).METHODS:Of the 119 type 3 gastric NETs diagnosed from January 1996 to September 2011,50 patients treated with endoscopic resection were enrolled in this *** endoscopic resection,endoscopic mucosal resection(EMR)or endoscopic submucosal dissection(ESD)was *** efficacy,complications,and follow-up results were evaluated ***:EMR was performed in 41 cases and ESD in 9 *** complete resection was performed in 40 cases(80.0%)and incomplete resection specimens were observed in 10 cases(7 vs 3 patients in the EMR vs ESD group,P=0.249).Upon analysis of the incomplete resection group,lateral or vertical margin invasion was found in six cases(14.6%)in the EMR group and in one case in the ESD group(11.1%).Lymphovascular invasions were observed in two cases(22.2%)in the ESD group and in one case(2.4%)in the EMR group(P=0.080).During the follow-up period(43.73;13-60 mo),there was no evidence of tumor recurrence in either the pathologically complete resection group or the incomplete resection *** recurrence was reported during *** addition,no mortality was reported in either the complete resection group or the incomplete resection group for the duration of the follow-up ***:Less than 2 cm sized confined submucosal layer type 3 gastric NET with no evidence of lymphovascular invasion,endoscopic treatment could be considered at initial treatment.

关键词： Stomach Neuroendocrine tumor Endo-scopic resection Treatment Carcinoid

Ampullary adenomyoma presenting as acute recurrent pancreatitis

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World Journal of Gastroenterology 2007年第20期13卷 2892-2894页

作者： Tae-Hee Kwon Do Hyun Park Kwang Yeon Shim Hyun-Deuk Cho Jeong Hoon Park Suck-Ho Lee il-kwun chung Hong-Soo Kim Sang-Heum Park Sun-Joo Kim Division of Gastroenterology Department of Internal MedicineSoon Chun Hyang University Cheonan HospitalCheonanChoongnam 330-721Korea Division of Gastroenterology Department of PathologySoon Chun Hyang University Cheonan HospitalCheonanChoongnam 330-721Korea

Adenomyoma is a term generally applied to nodular lesions showing proliferation of both epithelial and smooth muscle components. Despite its benign nature,ampullary adenomyoma is usually presented as biliary obstruction. Most cases are misdiagnosed as carcinoma or adenoma by preoperative endoscopic or radiologic procedure. Therefore,it is frequently treated with extensive surgery. To our knowledge,this is the first reported case in English literature of adenomyoma located in the peripancreatic orifice resulting in intermittent pancreatic duct obstruction and recurrent pancreatitis diagnosed by the endoscopic piecemeal resection.

关键词： Ampulla Adenomyoma Acute recurrent pancreatitis Endoscopic resection

Efforts to increase image quality during endoscopy:The role of pronase

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World Journal of Gastrointestinal Endoscopy 2016年第5期8卷 267-272页

作者： Gwang Ha Kim Yu Kyung Cho Jae Myung Cha Sun-Young Lee il-kwun chung Department of Internal Medicine Pusan National University School of Medicine and Biomedical Research InstitutePusan National University Hospital Department of Internal Medicine the Catholic University of KoreaCollege of Medicine Department of Internal Medicine Kyung Hee University Hospital at Gang DongKyung Hee University School of Medicine Department of Internal Medicine Konkuk University School of Medicine Department of Internal Medicine Soonchunhyang University Cheonan HospitalSoonchunhyang University College of Medicine

Clear visualization of the gastrointestinal mucosal surface is essential for thorough endoscopy. An unobstructed assessment can reduce the need for additional timeconsuming manipulations such as frequent washing and suction,which tend to prolong total procedure time. However,mucus,foam,and bubbles often hinder clear visibility during endoscopy. Premedication with pronase,a compound of mixed proteolytic enzymes,has been studied in order to improve mucosal visibility during endoscopy. Although its effects differ according to the location in the stomach,premedication with pronase 10 to 20 min before endoscopy significantly improves mucosal visibility without affecting the accuracy of Helicobacter pylori identification. The effects of pronase as premedication also extend to chromoendoscopy,narrow-band imaging,magnifying endoscopy,and endoscopic ultrasonography. In addition,endoscopic flushing with pronase during endoscopy may improve the quantity and the quality of a biopsy to some degree. Although improved mucosal visibility does not necessarily improve clinical outcomes,premedication with pronase may be helpful for increasing the detection rate of early cancers.

关键词： Endoscopy Premedication Pronase